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Sperm donation inside out

Saghar Kasiri, MSc, RC Path Diploma, MBA
Director of European Operations at Cryos International, Cryos International

Category:
Male Factor, Sperm donation

Sperm donation - inside out #IVFWEBINARS
From this video you will find out:
  • who needs sperm donation?
  • who are the donors?
  • what is their motivation?
  • how do sperm donors get screened?
  • how sperm donor are selected?
  • what are the legal and regulatory aspects?
  • how to make an order?
  • future siblings
  • the grey market of sperm donation
 

Sperm donation inside out

Everything about sperm donation

Everything you want to know about sperm donation: who needs it, who the donors are, why they donate, the screening processes the donors go through, and how patients can order sperm samples discussed by Saghar Kasiri, Director of European Operations at Cryos International. Saghar Kasiri, Director of European Operations at Cryos International started her presentation by introducing Cryos Sperm Bank, which is the largest sperm bank in the world with over 30 years of experience. Who needs sperm donation? These are heterosexual couples that are struggling with male-factor infertility. There are also same-sex couples and single women, both from heterosexual or homosexual backgrounds. The highest number of patients who are looking for a sperm donor are single heterosexual women, it’s 43% of them. The next highest group is women in same-sex relationships, which is 35%, and then there are heterosexual couples mainly due to male factor infertility at 18%, and 4% are single homosexual women.

The sperm donors – who are they?

They’re usually men that are around the age of 18 to 45 within that age range, they are healthy, psychologically and physically, more than 50% of them are in a relationship, and almost 50% have either graduated or are in pursuit of their higher education, 50% of them are in a full-time job, and 50% of them also donate blood. Most of them like to help others, and quite often they know someone in their family or friends that has had fertility issues, there is also some element of economic compensation, but the sperm donors only get paid for their time and effort as they need to take many trips into the sperm bank for screening, all the check-ups and then eventually for donation. The screening process is very thorough, and only 5-10% of applicants are accepted and become donors. The applicants start with an online application, which is quite long, and some applicants can be excluded at this stage already. Afterwards, sperm quality is checked with all the parameters, but the sample is also checked after freezing or post-warming to see how well the sample survives this process. After they are qualified, they fill in a screening questionnaire, there are questions on the potential donor’s history of the family, lifestyle and so on. Then, there are other evaluation tests, for example, their emotional intelligence is checked, but also they go through genetic screening, and infectious diseases screening. When they go through all the stages, and the results show they can be qualified as a donor, they receive a medical examination to make sure everything is fine, and then they can finally be accepted as a donor. It’s also important to remember what kind of donors are available. The main 2 classifications are Non ID – Release donors (anonymous) or ID – Release donors (non-anonymous). Anonymous donors’ identities will never be released to their future children besides their physical characteristics and also the important medical information about the screening, that’s usually the basic profile. The ID- Release donors mean that the future child will have the option to find out who the genetic donor was when they turn 18 years old. They will be able to contact Cryos and ask for that information, they will get the name of the donor, the date of birth and the address at the time of donation. There is also an extended and basic profile available. In the extended profile, besides all the information about the screening, you can also get more information on the donor, for example, childhood photos, and you could hear an audio of the donor. The information you get about the expended profile is very much to get more information about the actual donor without identifying information. Whether to choose an anonymous or non-anonymous is always a decision made by the parent or a couple, but also the location where they have the treatment done. Some countries only allow Non-ID-release donors, and some only ID-Release donors, there are also a few countries that give patients a choice to choose either of those categories.

Sperm donor selection

You can select the donors according to your preferences, you can choose by characteristics, and you can download all the information about the examinations and the screening of the donor. The extended profile includes a childhood, Q&A from the donors where they answer some questions, but also a personal letter, you can also have some background history about their families. There you can also find the staff’s impression of the donor while he was going through the process, and there is an audio recording of the donor as well. There is also a possibility to see adult photos, but those are available only if the donor is an ID-release donor. You will be able to see 5 or 6 donors’ photos that have been taken by professional photographers to provide you with as much information about the features of the donor as possible. There are also exclusive donors available, this means that you can choose a donor that has never been used for another family, and you exclusively purchase all the straws of that donor. After you’ve chosen your donor, you can choose what type of straws you need straws: ICI or IUI. ICI straws are unwashed and unprepared for sperm, they can be used by clinics that can process it in their own IVF lab. These straws can be used for IUI, IVF, and ICSI. On the other hand, IUI straws are already washed and have been already prepared in the IVF lab, those can also be used for IUI, IVF, and ICSI. Therefore, it depends on how your clinic recommends it. When you go on Cryo’s website, there is the step-by-step information on what you need to do to make an order. The delivery date is very dependent on where the sperm is being shipped, so sometimes it can take 1-2 working days in Europe, but it takes longer if it needs to be shipped worldwide. Give yourself around 4 weeks to select a particular donor, and bear in mind that some countries and clinics need to fill out all the necessary paperwork and will suggest when is the best time for shipping and when they are ready to receive the samples. If you are thinking of having more than 1 child, you should consider reserving more straws for future siblings. Plus, if you order only 1 straw and the cycle fails, you would need to book more, and this particular donor might not be available anymore. Therefore, it is best to reserve more samples, and you will be able to also use them for a future sibling. The straws are stored at Cryos sperm bank until you need them. Always be aware of the grey market out there. There is a growing alternative of independent contractors that are making an online grey market of free sperm donors. Keep in mind that this is not regulated, the sperm sample from such donors may be free or much less costly than the authorized licensed sperm banks, but these are underground sperm banks, and/or private donors, and this could mean that they didn’t have the screening, so there is a risk of sexually transmitted diseases, genetic diseases that could be transparent and there could be a possibility of legal complications. As there would be a lack of legal protection offered by a clinic, there is no guarantee such a donor would not be seeking contact or seek paternity rights.

Everything about sperm donation - Questions and Answers

I would like to know how important is the EQ profile in choosing a donor? Can it reveal important psychological or temperamental traits which could be transmitted to a future child? For example, is a score of 87 (EQ wise) low or representative for some emotional issues which could reveal something else?

EQ is important and it’s one of our criteria, but it’s not me the only determining factor. There will be stores that below a certain level, we may not accept them, not only because of their emotional intelligence, that can’t be passed onto the child. Mostly, it has to do with how confident they are about their donation. The well-being of our donors is just as important to us we must make sure that they are emotionally stable to donate, make the commitment and come through the process and also the implications of what it is in the future. So that is why they have many interviews when they come in, it’s not just the EQ test that we do on them but many interviews with our staff to make sure and establish who they are and they know the decisions they are making. Whether it’s that they want to be an open ID donor or non- anonymous or anonymous donor, what happens in the future with their family, will they tell all their family that they have donated, and when they are older will they tell their future children and so on. There are a lot of elements that are involved with regards to the donors themselves, and it is very crucial and very important that we establish that our donors are confident in their donation.

Is it possible for me to do the psychological test where you see the result online, so I can know more about myself to match a donor?

If it’s an extended profile of course, not for the basic profile. By clicking at the bottom of the document, you can see the result of the EQ of the donor, So whether you can match it with yours, I don’t know. That’s a great question, I haven’t come across that, but if you do EQ yourself whether it is matchable or not, that is something that you perhaps can check with the centre that you do the testing with, or with our customer services. I’m sure they can look into it.

How do the donors decide which category of donor they want to go into? Non ID or ID release? Also, do Non ID release know that they could be contacted through genetic testing in the future even if they may have hoped to remain anonymous?

First of all, we provide counselling to them to make sure that they understand the implications between different types of donation. As I’ve explained, not just now but in the future when they have their own family and if they have their own family, how they feel about it. There are a lot of genetic websites where they can do DNA on themselves, and so on, it is possible now to trace the donors that didn’t provide their ID, and this is something we specifically talk to them about, we put it in our consent form if they want to be non-ID released, we propose them not to go to the websites that would give that kind of information about their DNA. However, we also do warn them that nowadays, it’s so widely used around the world that even if they directly won’t go and provide their DNA, some family member may still be possible to trace them. So they are aware of this and therefore you kind of consult on that as well.

What is the typical number of donor children that donors produce? I know some countries have ‘family number limits’, but others don’t. Does Cryos have any maximum number of families? How many halfsiblings can a child expect to have?

Even though some countries have their own pregnancy limits or family limits as they call it like in the UK and Spain and so on. In Cryos, we also keep a close eye on that. We ship to over 100 countries worldwide but still, we try and make sure that we don’t have more than 25 to 50 children around the world, so they will be scattered around the world, but we make sure that we would not go over that limit between 25 and 50 for each donor.

Do you allow or restrict the families from trying to find/contacting halfsiblings whilst the children are still young? I understand in the USA it is usual to try to find halfsiblings, even though the donor only is known when a child is 18.

We have an eternal agreement with our customers, and we ask them not to try and trace the donor, but unfortunately, if the customers break that term of the agreement, it’s very difficult for us. We will not provide the information until the child reaches 18, and if the child has been born as a result of ID-release donor, only then we will provide the information about the donor. But other than that we strictly recommend it, but obviously, we cannot stop, and we will not facilitate finding halfsiblings.

Are you experiencing a lack of donors during Covid-19? Will there be fewer donors to choose from now?

No, not at all, we’ve got over 1,000 donors and, so if it’s not going to run out. There’s plenty of choices available.

My husband and I have done 10 rounds of IVF but one particular sample of 30 straws we’d like to use has the best quality. The clinic did infectious diseases test 7 months before but the clinics in Ukraine we’re thinking about using now don’t accept any samples unless they have an accompanied report of no more than 2-3 months prior or after the sample was given. So my question is can infectious diseases tests be done on already frozen sperm? Who can do this in the US, can a hospital or the FDA?

I can explain to you how we do the testing. We do the testing, for the infectious diseases right at the beginning and throughout the whole donation, so that we know after the last donation and the quarantine period and so on, that the donor reveals the time they have donated to be completely cleared from any infectious diseases. Well, it depends on the country as there are different regulations, whether a post frozen sample can be tested for infectious diseases and whether that would be acceptable or not. If post freezing the sample if they test the husband and it is completely clear than in some countries they may be able to use it, but again that depends where they have done it, and I wouldn’t know the details of every country and situation. By all means, get in touch with us, we have got our US customer services, and I’m sure they would be able to assist you with your query.

When I filtered donors, it said country: Cyprus. Does that include North Cyprus?

We ship to many countries, we work with clinics in North Cyprus. I don’t see an issue, but I think customer service can give you more details about it.

If the donors and sperm are screened so thoroughly why would you recommend ICSI, as one of the uses – my understanding is that ICSI is mainly used for male-factor infertility? Are some for the sperm therefore not optimal for IUI or IVF uses? My experience has been a donor with low HBA and therefore failed IUI and donor was not suitable for IVF, I had to resort to ICSI.

We don’t recommend ICSI, the clinics and the medical doctors make that decision. Because I am an embryologist, I can tell you from my own experience. Sometimes the doctors decide on ICSI even with donor sperm if they are f. e. worried about the thickness of the zona or the wall around the egg, or they have any concerns with regards to the binding between the sperm or the egg. Now, no one can predict if that would be the case, now we don’t do HPA testing because it has not been part of the approved test that is agreed by all medics and embryologists who are working in this field. You can search for many clinics which don’t agree with doing the HPA testing especially for donors that have had pregnancies in the past from their donation, it’s not non-relevant. Also, there is a huge disagreement on what level would you call normal HPA which is binding between the sperm and the egg which is very high at 95 %, and some are saying 75% is fine. Because of these variations and because it really hasn’t had a clinical proven use of HPA, we are not going to test our donors so especially if they’ve had a pregnancy in the past.

Regarding the limit of families in the UK. I understand the limit is 10 but does that only apply to UK based families? Can the same donor provide sperm for more families outside of the UK?

Yes, so you can expand, but the same donor can be used in other countries before it reaches the limit of that country. So, yes outside the UK the donor is available but in the UK the donor will be blocked as soon as it gets to 10.

How is the limit of 25-50 children worldwide achieved? Does this mean 25 families, who might have more than one child each? Or up to 50 families?

So we are looking at around 25 families worldwide who will have some siblings, so we are saying 25 to 50 children, so hopefully, with the families that have reserved donors for their future siblings as well, we have some control. Don’t forget that we keep the record of where the sperm has been shipped, and we will try and keep those pregnancies as well. It’s hugely important that our patients and customers come back to us and report their pregnancy within after the first trimester and also once they have a successful and healthy baby deliverance.

Do you have also African donors sperm?

We’re lucky because we have 2 locations in the US and the EU, and we do have some African donors. You will find more of them on our US website, in Denmark we mostly have Caucasian donors, but we do have them, and if you look on our US website as well you might be able to see some donors with more ethnicity backgrounds there as well. A lot of the donors even if they are not from the same ethnicity, they could have the same phenotype or characteristics or similar dark hair, dark skin, dark eyes and so on, so you can always try and match according to that as well.

Do you offer frozen oocytes as well?

Yes, we do. Our US egg bank provides the frozen oocytes, they’re actually very successful in the US with our frozen eggs because they have done great since 2015 when we opened the bank there. We’ve got a 92% survival rate from our frozen eggs and 86% fertilization rates and over 75% pregnancy rate with our frozen oocytes. It’s a very good program we are running there, and it’s available as well for patients.

How many times are the egg donors allowed to donate?

It depends, 4 to 6 times will be allowed. It depends on the quality of the eggs they produce.

May people from countries where sperm donation is illegal to have a chance to donate sperm in other countries?

I guess if they have permission to be in that country that they are not from and they have visas or permission to stay there, then yes. They have to have at least some kind of residency and a long term commitment to the program, they cannot just come in, donate and leave because it is a long term process that needs commitment for quite a few attendants to the sperm bank, in order to be able to donate. If it is illegal in their own home country, but they are a resident, students or working in another country, that allows the sperm donation then, by all means, they go according to the regulation of that country.

How long typically is a sperm donor available for on your website? Do they ‘sell-out’ quickly, or are there for some time? And if I like a donor who doesn’t have any straws left, will there be more, if I need more?

It’s difficult to say, how long they stay on the website. It depends on how popular they are or how many times they’ve come in to produce the sample. Some donors that we find that the quality of sperm is good and they over the long term, they keep coming back and producing sample. However, if the donor produces a sample for some time and then decides that they don’t want to produce anymore, obviously we cannot guarantee that he comes back and products more. So the best thing to do, is to reserve a few straws, minimum 3 we would say for each treatment, so you have one, but at least you have 2 back-ups for future treatments, in case the first one doesn’t work. Also, you can choose more than 3 if you wish, especially if you want to have a sibling and so on, we will give 75% of the money back, and we can keep it for many years for you, so that’s not a problem. With regards to if they come back if they need more, we can provide it unfortunately, there’s no guarantee because if we run out and we cannot get the donor to come back, that’s it, they have to be willing to donate.
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Authors
Saghar Kasiri, MSc, RC Path Diploma, MBA

Saghar Kasiri, MSc, RC Path Diploma, MBA

Saghar Kasiri is the Director of European Operations at Cryos International. Saghar Kasiri is a Healthcare professional with an Executive MBA with Distinction from Cass Business School, with a background in Clinical Embryology and Fetal Medicine, and a track record of combining medical and scientific knowledge with commercial expertise having managed departments both in the NHS and private sectors. She has received the Business Woman of the Year Award for providing an insight into the transformation of UK healthcare management. Her background speciality is in Clinical Embryology and she has an MSc in Preimplantation Genetic Diagnosis & Fetal Medicine, and over 25 years’ experience of working in the fertility field.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.
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